The abuse of cocaine has become a serious problem in all segments of society. The non-medical use of cocaine by pregnant women is of particular concern because prenatal exposure to other psychoactive drugs including alcohol and opiate derivatives results in acute transient effects like neonatal withdrawal syndrome (NWS) and in long term developmental problems for exposed infants. Existing reports of the neurological and behavioral effects of prenatal cocaine exposure are sparse and inconsistent and do not discriminate the effects of cocaine from those of other drugs of abuse. Identification of cocaine exposed neonates at high risk both neurologically and emotionally will permit more effective medical and social intervention. Therefore, the goal of the present proposal is to: 1) document neurological and behavioral correlates of prenatal cocaine exposure, alone and in combination with alcohol and marijuana, in order to describe specific patterns of behavior corresponding to cocaine withdrawal in the first days of life; and 2) to document evidence of neurobehavioral deficits during the first month that indicate later deficits. To control for the interactions of drugs and other factors, cocaine exposed neonates (n=30) will be compared to infants in three contrast groups from the same population; 1) non drug exposed; 2) both cocaine and alcohol exposed; and 3) alcohol exposed. Because so little is known about cocaine's effects, multiple assessments of medical and neurobehavioral status will be used: 1) medical and dysmorphic examination at 3 and 14 days of age; 2) neurobehavioral assessments at 3 and 30 days of age; 3) behavioral observations of infant state regulation and organization at 2 days of age; and 4) analysis of infant pain cries which are predictive of later cognitive outcomes in neurologically damaged infants. Our hypothesis is that cocaine exposed neonates will show a pattern of behavior in the first month of life which is analogous to the pattern of post-abuse symptoms observed in adult cocaine addicts. Furthermore, their behavior will be dependent on the interval between birth and their mother's last cocaine use. We also predict that deficts noted at three days will persist until 30 days indicating that these infants are at high-risk for later developmental deficits because of their exposure to this potentially teratogenic substance.